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Aims:

The Oxford Suspected Cancer (SCAN) Pathway aims to reduce the time that patients who have vague symptoms that could be cancer wait to be diagnosed. In doing this, we also aim to increase the number of patients that are diagnosed at an early stage in their illness.

Why is this important:

A diagnostic pathway is the route that patients take from first presenting their symptoms to a clinician to receiving their diagnosis. People who visit their GP with vague symptoms often do not meet the criteria to be referred for tests and so can experience long delays before they are diagnosed. This is not only frustrating for the patient but means that if they do have cancer or another serious disease, it could have progressed and become more difficult to treat by the time they are diagnosed. Faster and earlier diagnosis also means that patients’ experience of being diagnosed may be improved.

Currently, fewer people survive cancer in England than in other similar European countries. Researchers have estimated that 5,000 deaths from breast, colorectal and lung cancer could be prevented each year if these cancers were diagnosed earlier. To try to achieve this, Cancer Research UK (CRUK) set up a programme of research in partnership with other charities, UK universities, and hospitals called the ACE project. The first stage of research in the ACE project was to identify what the barriers were to diagnosing cancer more quickly. This research found that people with vague symptoms like pain, fatigue, and weight loss often had many, sometimes inappropriate, tests and could experience long delays before they were given a diagnosis. The second stage of the ACE project is to design and test new diagnostic pathways to speed up diagnosis for people with these vague symptoms. The Oxford SCAN Pathway is one of the pathways being tested to try to achieve this.

Methods:

GPs in Oxfordshire are being encouraged to refer all patients aged 40 and over with vague symptoms to the SCAN Pathway if the GP thinks there is a chance they have cancer. These patients will quickly be given blood tests, a stool test, and a CT scan. Once the clinical team has the results of these tests, the patient will be referred either to a specialist clinic or on for more tests and discussions with a team of clinicians from a range of medical specialties.

We will be testing whether people referred to the SCAN pathway are diagnosed more quickly and at an earlier disease stage than those with similar symptoms who follow the pathways that have been used up until the introduction of SCAN and comparing their long-term outcomes. As well as this we will be asking GPs and patients about their experience of the Pathway, and calculating whether the costs and benefits involved in the Pathway make it more or less cost effective than existing pathways.

How could this benefit patients?

We estimate that during the two years that we will be evaluating the SCAN Pathway over 1,200 patients will have been referred to it, allowing us to get a clear picture of whether it is an effective way to diagnose patients with vague symptoms. If we find that it is, the Pathway could be adopted more widely giving patients living outside of Oxfordshire the chance to have their vague symptoms diagnosed more quickly.

We are also setting up an additional project alongside this work called Suspected CANcer Biobank (SCAN Biobank).